Under the label “Supported Employment,” services that promote competitive, integrated employment (CIE) for working-age adult with intellectual and developmental disabilities have been federally funded since the 1980s, alongside other more traditional day habilitation and segregated or sub-minimum wage employment services. However, since the early 2000s, over 30 states have adopted “Employment First” policy, prioritizing competitive, integrated employment (CIE) as the preferred outcome, and in some states, restricting alternative service options. And while researchers have made a considerable effort to understand system-level determinants of participation in CIE-focused services, little attention has been paid to the political factors driving these major changes in the overall policy mix. Moreover, the Employment First changes, which have attracted little public attention or controversy, vary considerably across states in timing, form and content. What do these policy changes look like, and how can we explain both the occurrence of major policy changes and the variations in timing? Using a three-manuscript format, the study applies a mixed method approach to two cases, Washington and Pennsylvania.